SMOOT: Dr. Noonan, to begin this morning would you tell me a little bit

about yourself, your, your background, your--

NOONAN: --oh, all right--

SMOOT: --family, education--

NOONAN: --okay--

SMOOT: --et cetera--

NOONAN: --well, I guess you'd have to call me sort of a Yankee. I

was born in Burlington, Vermont, but moved to Hartford, Connecticutwhen I was still an infant, about nine months of age, and grew up inHartford, Connecticut. Went to grammar school and high school thereand went to college in New Haven, Connecticut, uh, Albertus MagnusCollege, and then went back to my home state, uh, Vermont, and wentto medical school at the University of Vermont. Uh, I graduated fromthe University of Vermont in 1954. Um, I was the first person in myparticular family to have gone on to college, and, or certainly onto medical school. Uh, the oldest of, um-- I have two sisters--I hadanother sister that died and a very supportive family that supportedme in my career and all that. Um, when I finished medical school, my1:00internship was in Chapel Hill, North Carolina. That was sort of thefirst time I'd ever been south of the Mason-Dixon Line. That was aninteresting, it was a good intel-, educational experience, and it was,uh, interesting. Um, I then went to Cincinnati Children's Hospital formy pediatric residency, and that's the first time I'd ever, uh, beento Kentucky. It was interesting that some of our most fascinating,interesting patients when I was a st-, a resident at Cincinnati werepatients from, um, Appalachia. Uh, at that time, the children fromHyden--the Frontier Nursing Service--uh, referred their patients tothe Children's Hospital in Cincinnati. This was in the days whenhospitals were willing to give free care and, of course, there wasn'tany Medicaid and many of these patients had no funds. And, uh, so thatthe, uh, uh, they were sent to, uh, Children's Hospital for, uh, some2:00really, uh, pretty complex, serious kinds of problems. Um, and it wasinteresting that almost--some of the most fascinating patients had comefrom Kentucky. I also, um, one of our, um, future faculty members,Dr. Nancy Holland, who was then Dr. Nancy Hinkle, was a resident withme at Cincinnati, and she's from Paris, Kentucky. And we had been toParis, uh, as residents; she had taken us to her home--we'd been toKeeneland. (Smoot laughs) And so I had some, uh, understanding of,uh, Kentucky. I did not really have any idea that I would be backin Kentucky when I left Cincinnati. I went then to Boston Children'sHospital where I did my, uh, training in pediatric cardiology. Um,I finished there in 1959, and at that time pediatric cardiologistswere in demand. Uh, every medical school wanted one; there weren'tmany around. So just as I finished my training, uh, there were job3:00opportunities. And I ended up going to, uh, the University of Iowain Iowa City, Iowa to be their first pediatric cardiologist. And, uh,I was there for two and a half years, and that was a very interestingexperience, and I think, uh, a big job for somebody just finishingtheir, uh, training. Um, and while I was there doing that, uh, Ireceived a letter from Dr. John Githens, who was the first chairman ofpediatrics at the University of Kentucky. Dr. Githens had come herefrom Colorado and he was looking for a pediatric cardiologist, becauseevery school wanted one and there weren't, uh, an over abundance ofthem at that time as there are now. And so he wrote and, uh, invitedme to come for an interview; that I had been recommended by somebodyas a potential candidate for pediatric cardiology. Um, I was happy4:00in Iowa City; I wasn't anxious to leave. But it turned out that thechairman of pediatrics in Iowa was also leaving to take the job aschief of, uh, pediatrics at Cornell. That was Dr. Wallace McQuarry,so he was leaving. That made it a little bit easier for me to considerleaving, but nonetheless, I did not accept his invitation to come foran interview right away. I said, "Well, why don't we meet and talkabout it at the spring meeting?" There is a--used to be in AtlanticCity every year--the Society for Pediatric Research met every year inAtlantic City. I was going to that meeting and so I thought, well,I'll see what this Dr. Githens is like. I'll hear a little bit moreabout it before I, you know, go to look at a job. So we sat at the--in, uh, Atlantic City, and, uh, Dr. Githens is a very fine person. Wasenthusiastic about the, uh, new school, and, uh, although I had juststarted a pediatric cardiology program where there had been none, there5:00had been adult people. And there were children with heart disease andthere was already some pattern developed about expectations and allof that, which was a little different than starting from real scratch,because these children had been seen by the adult people first. Ithought, well, you know maybe it'd be fun to start really right fromscratch where everything is, is brand new and you do things the wayyou'd like to see them done. And so, um, after I talked to him I diddecide to come for an interview. It was interesting, when you camefor an interview for a new faculty position back in 1961 here at theUniversity of Kentucky, uh, there were very few people in any onedepartment. And, uh, they were very--it was very important to, to DeanWillard and to the chairman who were here that they have a very--sortof a compatible group, people that would have the same philosophy.And, uh, so that instead of being interviewed just by people inyour, uh, department and maybe a few others, I think I saw about every6:00chairman that, at the time I saw, uh, George Schwert and Bob Straus andBen Eiseman and, you know, Harold Rosenbaum. I think about everybody--Ed Pellegrino. These were all people that I saw coming as an assistantprofessor in the Department of Pediatrics. And, uh, they had lookedat a couple of other candidates, so I was, oh, one of several they werelooking at. I stayed with Jack Githens at his home over on Parker'sMill Road. There weren't all the hotels we have now. And it was avery, uh, uh, it was a very warm place with, uh, a vision. Uh, thehospital at that time was still being built. It wasn't completed.You could see where pediatrics was going to be. Um, and I thought,gee, this, this sounds like fun. I, I, it was close to Cincinnati andI had, uh, good memories from Cincinnati. Uh, the faculty they wereattracting were certainly very outstanding. Uh, and so, uh, they,7:00uh, offered me the position really very soon after I came and, and Iaccepted, and actually came in, um, in December of 1961, uh, to, uh,Ken-, to Lexington. And, uh, I've been here ever since, uh, and it,it was, it was an exciting time, and it's, it's fun to look back at,uh, things now. I came from Iowa where I was very busy doing cardiaccatheterizations, having a big clinic, working hard and all of this.Came to the University of Kentucky Medical Center where the hospitalwasn't opened yet, where there weren't any patients, where there wasnothing. Uh, we did have a lot of meetings, um--(Smoot laughs)--butwithin a very short, and I, of course, I'm really basically a clinicianand, uh, that was not, uh, very interesting to not have anything to do,so, uh, I don't think I'd been here but a few, uh, weeks when, uh, I8:00went on one of our first regional heart clinics, which I've been goingon ever since. Dr. Githens and myself and Dr. Jack Reeves, who washere in medicine and cardiology, we went all over Eastern Kentucky aswe still do, and went on, I came at the end of December, almost thefirst of January and by the end of January we were going on our firstregional heart clinic. In addition, Cardinal Hill Hospital, we had,uh, an affiliation with them at that time. One of the pediatricians,Dr. Kenneth Dumars, that had come from Colorado with Dr. Githens,uh, was, uh, the--in charge of the medical program over there. And,uh, there were some children with cystic fibrosis who were over there.There were some children with other kinds of problems. And, uh, Iadmitted a patient with rheumatic fever, so that I did have a patientin the hospital over at Cardinal Hill. Um, some of the pediatriciansin town here, who knew I was coming, uh, sent few patients and I saw9:00a few patients in my office in the hospital before the hospital reallyopened. The hospital did not open until April of 1962, so I was hereseveral months before the hospital opened. Uh, and once the hospitalopened, uh, by that time we'd been to several clinics, and, uh, thevery first patient admitted to the University of Kentucky Medical Centeror A. B. Chandler Medical Center, uh, was, uh, Margaret Schoolcraft,a child with a patent ductus arteriosus that we had seen in one of ourregional clinics and had all lined up to come to the hospital when itopened. Uh, so that was sort of exciting that the very first patientwas a patient with congenital heart disease admitted to, uh, to UK.And, uh, uh, she was not the first operation, however. Uh, theydid a mastectomy for their first operation, because for some unknown10:00reason, uh, the nurses thought that would be, uh, uh, less complicatedpost-op care than a patent ductus because that's--they thought thatwas heart surgery. Of course, patent ductus arteriosus post-operativecare is really probably much simpler than a radical mastectomy, butnonetheless--(Smoot laughs)--uh, uh, uh, she was the second case. Um,looking back at the patients that we saw in the hospital, uh, when itfirst opened, we, we opened on the fifth floor, I think five west waswhere the hospital opened, and, uh, everybody was on the fifth floor.Uh, and, uh, there was a premature baby and a patent ductus and a boywith a hernia and, uh, uh, and then adults. It was a, it was a funtime. And, uh, I think at the beginning many of our patients were fromEastern Kentucky. These were patients who probably had--didn't havemoney, had never had any care. And so at the very beginning we sawchildren with just very serious, long-term chronic illness. Children11:00just very infested with parasites--worms--that came with bloatedabdomens, uh, malnourished, and our hospital would have these childrensometime there for weeks or months getting them back into some kind ofreasonable nutrition. Uh, to look at our hospital today and what itwas like, uh, uh, twenty-four years ago, uh, is, uh, very different.Uh, you know, they're in and out of the hospital quickly. They arein with very serious illnesses, they're, uh, where previously theywere, many of these were, uh, children with diseases that, uh, werenot common in the rest of, of, uh, Lexington at that time. Childrenwith tuberculosis might be in the hospital for many weeks or months.Um, bad cases of osteomyelitis--bone infections--that had gone, thathad been neglected. And we had interesting patients, of course, atthat time it was before television had reached Eastern Kentucky, and12:00coming to Lexington to this big hospital was a real experience. Manyof the patients had never seen an elevator. I think some of them hadnever seen flush toilets and the like. And so it was a big adventureand very scary for them. Uh, I, I fell in love with the people fromAppalachia actually when I was a resident in, uh, Cincinnati. And,uh, so this was a--they're such a very warm, uh, people, and we, uh,certainly had some wonderful stories to tell through the years as, uh,we took care of patients from, uh, Appalachia. They've become muchmore sophisticated now, television has come, nothing, they sort of are,know everything that's going on now. But in, in those days it reallywas a real adventure coming on the elevator. And, uh, I don't knowif they still do, but children start smoking fairly early in EasternKentucky, and I can remember we had--(laughs)--you know, when I thinknow we're trying to stop smoking throughout the hospital, and where onthe pediatric floor our pediatric patients were going in the elevator13:00to have their cigarettes because the nurses wouldn't let them smokein their rooms, uh. (Smoot laughs) But, uh, we did have a number ofchildren who, uh, were still on pediatrics, but, uh, were smoking. Uh,that has, I think at least they're not smoking as--on the pediatricfloor right now, uh, at least not that we know about. (Smoot laughs)Um, but it, it was an, an interesting time and, uh, very interestingpatients. Uh, I--the, uh, the pathology, the sort of neglecteddisease, disease that had gone on for a long time was present. Uh,different people responded in a different way to this. Dr. JackGithens--John Githens--our first chairman, wonderful person, uh, didnot stay here long in Kentucky--went back to Colorado. And part ofthe reason, uh, that he went back I believe was that he was so moved bythe, the disease, the poverty, the everything in Appalachia. This, uh-14:00-he really, it was difficult for him to deal with this. He, he coulddeal with it, he was wonderful administrator, but once the patientsstarted coming and he had to see this, I think it was difficult forhim. Um, I saw the same patients and my response was very different.My response was, gee, isn't it wonderful we're here. They've gotsomeplace to go now. And so I looked at it as we were doing something,uh, good for those people and we were learning a lot from them. Andso my, uh, uh, response was very different and has I guess continuedto be that way. And what is really, uh, remarkable is with the roadsthat came to Eastern Kentucky--television, Medicaid, AppalachianHospitals, and all of those things. The, the health care and all ofthat is just, you know, you could just see it change before your veryeyes. I mean, we don't get children in terribly infested with wormsanymore. We don't see those kinds of patients anymore. Um, not that15:00there are not still problems and that there are not poor people, butthe health care is available and I think we, the University of KentuckyMedical Center, had a very big role to play in improving the healthof people of Eastern Kentucky. Uh, we've been going out there formany years. Pediatrics has gone to regional heart clinics; we've gotpediatric clinics. Dr. Vandivier goes all over the state lookingat, uh, lung disease and tuberculosis. So that our first communitymedicine people are out in Inez and Martin, Kentucky doing their thingwith TB. So we really did go where the p-, pat-, patients were, wherethe problems were, and I think developed a referral system for patientsto come here and what's more we, we trained a lot of doctors. Andpeople forget that the doctors that are out in Eastern Kentucky now,the younger ones, majority of them have come from this medical school.And so we have provided, uh, physicians for all of Eastern Kentuckythat were not available. There may not be as many as they want, but16:00there are more than there were. And, um, I think we have, uh, we'vealso, I think, helped to, uh, perhaps improve the image of medicine topeople in Eastern Kentucky. When I first came here, many of the peoplewere really afraid of hospitals. They look-, looked at hospitals asa place where you came to die. People went to the hospital and died,they didn't get well. And this was a self-fulfilling prophesy. Theydidn't really have any money; they certainly wouldn't go to the doctoruntil they were really sick. And then you went when you were verysick and you didn't get better. So it was--and as they began to usethe hospital and got well, it was sort of very exciting. And as acardiologist, you know, to go down to, um, Eastern Kentucky, a littletown where they might not have any electricity, but you got patientswith heart valves and pacemakers and have had open heart surgery--themost sophisticated medical care. And they go back to, uh, uh, youknow, uh, they'll say, well, I had, you know, I had trouble getting17:00across the, the, uh, uh, you know, when they lived in the hollers,that the river would come up in the spring. They might not be ableto meet their appointment because the river had risen. But there theywere with the latest of, uh, of, uh, care, and, uh, uh, that, I thinkthis was to me, uh, a very, uh very heartwarming that the, uh, MedicalCenter here could, could provide tertiary, uh, state of the art, uh,medicine to the poorest people in, in Appalachia. And, uh, I think,you know, we're, uh, I don't--I hope that we'll st- --going to be ableto continue to do that. I certainly hope we will, uh, but we certainlydid that, uh, for many years, and at a time when there was really noMedicaid to even help reimburse, uh, what we are getting, uh, now.Although it doesn't reimburse very well, it--(laughs)--it's betterthan nothing, which is what we got then. I can remember a numberof, uh, patients, uh, I can remember one lady very well. Uh, her son18:00had, um, severe mitral stenosis. This is a rheumatic heart diseasecondition that generally in the United States, even at that time, wassomething you saw in peoples in their thirties and forties, fifties.In India you saw it in children. In Kentucky we saw some in children,and this was a, a young man, uh, child with, uh, mitral stenosis. Andwe brought him in for surgery and, uh, everything went well. And, uh,when I went out to the, uh, recovery--to, uh, the waiting room aftersurgery to tell his family everything had gone well, then, um, thegrandmother said, "Miss Noonan," and, you know, in Eastern Kentucky,um, when they like their doctor they call them, they might call them bytheir first name. So they called me either Jacqueline or Miss Noonan.And I--(Smoot laughs)--did not--I took that as a compliment becauseI think that's way, the way they meant it. And, uh, this, uh, lady19:00said, uh, "Miss Noonan, well, I believe you all done such a good jobwith, uh, Raleigh, I believe I'm going to let you take care of me now."And--(Smoot laughs)--it was really, it was, uh, it was really, uh, it'sa very--the people in Appalachia, by and large, have a very personalrelationship with their physicians. So that, uh, our house staff usedto get upset because a patient would come in and they'd start doingtheir things and they'd say, "Dr. Noonan's my doctor," you know,and--(both laugh)--they, they would put up with these other doctors,and, uh, uh, you, you become their doctor. And you become their doctorfor the whole family, even though you might be able to sort of say,"Well, this doctor will help you with this." It's a very personal kindof a relationship, and, uh, one that I, I, I did enjoy, and do stillenjoy. And, uh, it's hard to imagine, but, uh, I go to regional heartclinics all over Eastern Kentucky, and we go to most of them like oncea year. But I would, uh, say that probably for many of those patients20:00they have seen me more frequently on a recurring basis than they haveany other doctor in Eastern Kentucky, because they see me every year.We go back and they see the same doctor. And, uh, if you go out toEastern Kentucky, although there are more doctors there, these are,by and large, doctors that don't stay very long. They come and dotheir National Health or they do their missionary work or whatever.And so the, the, uh, there's a pretty rapid turnover of physicians.And, uh, uh, it's hard for these people then to get a real personalrelationship because they don't have that doctor that's there day andnight all the time. And, uh, they have the phone and they call downhere, but that's, that's something that, uh, that I, uh, uh, have, uh,felt. Uh, it does, I think for a physician it, it's one of the sort ofthings that makes being a doctor worthwhile, is this sort of personalrelationship you get. And, um, uh, it's sort of nice because most of21:00them are a hundred or two hundred miles away rather than right nextdoor here, so--(laughs)--but, uh, but it's a, it's a--I've enjoyedthat. Um, I've enjoyed being at UK, uh, for many, many reasons, butthe patient population has certainly been a big part of it. To behere in Lexington seeing very sophisticated university people, uh, richhorse people, the poorest people from Appalachia, and, uh, the abilityto be able to see all of these patients in the same clinic by the samedoctor; all receiving the same kind of care, is something that I have,uh, have enjoyed and hope we will continue to be able to do.

SMOOT: You obviously love your work.

NOONAN: Yes, um-hm.

SMOOT: What motivated you to go into pediatrics in the first place?

NOONAN: Well, when I was a--I wanted to be a doctor since I was five,

so I decided on that fairly, fairly early. By the time I was seven,I wanted to be a pediatrician. I, I don't know how much I knew aboutpediatrics, but I liked working with children. And so when I went tomedical school I, I knew I wanted to be a pediatrician, and the, um,22:00but I didn't know what I wanted to do in pediatrics. I hadn't reallylooked beyond, you know, what I would do after I was in pediatrics.Uh, I remember in medical school, however, Dr., uh, Jim McKay wasthe chairman of pediatrics at Vermont. And I remember thinking, gee,he has a fun job because he was there teaching medical students, hesaw all the interesting patients that came in the hospital. And theother doctors were out giving baby shots and seeing these--I sort ofliked being where the action was and I really--that, I, I'm sure inmy wildest dreams I never dreamed I would be chairman of a Departmentof Pediatrics some years later. (Smoot laughs) But way back then Ican remember thinking, gee, that looks like a fun job. So I went thento do pediatrics and, um, in the s- --as I finished, was finishingmy pediatric training, um, I said, gee, you know, I'm going to haveto, I've, finishing my training, I'm going to have to do something.And, uh, I liked everything. I mean, I liked endocrinology, I liked23:00newborns, I liked cardiology; I liked everything. But I thought Ireally wanted to learn more about something, and cardiology had sortof fascinated me. I took three months of pathology as an electiveduring my, and, uh, and, uh, looked, looked at the anatomy of thecongenital hearts; I was fascinated by that. And, uh, so I ended up,uh, going into pediatric cardiology and was fortunate enough to go toBoston Children's where they had--Dr. Alexander Nadus was my mentor.And, uh, uh, you know, probably--I'm sure he's the best clinicalteacher there ever was. So that was a wonderful experience at Boston.And, um, so I, I did my pediatric cardiology at that time, and, uh,I've always thought of myself as a pediatrician first and a pediatriccardiologist, uh, second, uh, because when you do take care of childrenof heart disease, you sort of have to take care of the whole child.You can't just limit yourself to their heart. And, uh, I was veryhappy being a pediatric cardiologist here at Kentucky. And, uh, uh, I24:00guess probably I had more fun when I wasn't chairman than I do when I'mchairman. That's, this is not, you know, being chairman is not quiteso much fun as being a pediatric cardiologist. But because I knew Ineeded to, uh, continue to be active clinically, uh, I've--I'm, I'mafraid I've never given up one of my jobs when I've taken on anotherone. So, uh, when I did become, uh, chairman of pediatrics in 1974, Icontinued to be, uh, chief of the pediatric cardiology division and anactive pediatric cardiologist. I still do cardiac catheterizations. Istill take call every third weekend. I still take a month of pediatriccardiology every third month. Um, and that becomes frustrating in thatI, I sort of have the feeling I don't do any one job as well as I couldif I had more time to do them. Um, but I, I sort of, uh, also feel25:00that a chairman of a clinical department needs to be a doctor. I mean,I don't see how you can be a good role model for house staff -- how youcan understand your faculty if you spend all your time in your office.And fortunately, pediatrics is a relatively small department--not verysmall--(laughs)--but a small department. So you can do both. It justhappens that pediatric cardiology is a--it's a busy service so it'sa little harder to do all of that plus do your, your other things aswell. Um, I'm not married--I've never married, so that, uh, uh, my,uh, my job is my, uh, my total commitment. And I think that's why Iam able to do both things. But it's frustrating because, uh, it's,it's hard to always do as, uh, all the things that's expected of youon all areas and, uh, you know, to have to go to meetings. I, I haveto really pretty much live a fairly scheduled life and, um, I have to26:00set priorities. Uh, my administrative job as a department chairmanobviously has to assume very high priority. Uh, if I am involved asa, uh, clinician and have patient care responsibilities, uh, if thereis, uh, a problem there I have to then rely on one of my other twocardiologists to, to do something for patients if my chairman job isessential. Uh, uh, by and large, patient care comes first, but thereare times when I might have to delegate patient care to do my otherjob. Um, so those are the kind of decisions you have to make and it's,you know, just a little bit--sometimes frustrating. Uh, being chairmanis not anywhere near as much fun as being a pediatric cardiologist.Uh, part of the thing is that when you become chairman, you lose, um,some of the wonderful peer relationship you have with your faculty.You become them, you know--(laughs)--and I, I really didn't think I27:00changed. I thought I was the same person, but to everybody else younow become part of they, that they that does all these things. And,uh, uh, that's sort of difficult because, uh, you know, people treatyou differently. They, uh, they, they talk nice to you on one handand talk behind your back on the other hand. And, uh, uh, you alsolearn that, uh, by and large, uh, most faculty are most interestedin themselves, and that people as a group are relatively selfish.And, uh, as a department chairman, you have really to be responsiblefor a, a whole department. Uh, I don't think you can be a good, uh,department chairman if you are not unselfish. And I think that you,uh, if you're going to be a good department chairman you have toreally have very much in mind the, the, the Medical Center itself--theuniversity. And, um, and there are conflicts because what's good forone thing may not be good for the other. And so you, you sort of are,28:00uh, you have to do what you think is right, but I think if you are adepartment chairman, you have, and are going to stay a chairman youhave to be part of the, uh, the establishment, because that's--you arean administrator and that's--your loyalty is to the administration.The challenge is, can you affect administration by, you know, yourrole in things? And, and I, I, I feel that's, that's to me is thechallenge. Uh, uh, the thing that makes it worthwhile is that you,uh, that I do feel I do play a role in this. I do, uh, play an activerole, in, um, in things that do happen at the Medical Center. Theycertainly don't always do the things the way I'd like them to do it--(both laugh)--but I do have, I do have a role in it. And, uh, I thinkthat, uh, that, that is a, um, that's a challenge that makes the jobof chairman, uh, worthwhile, uh, because, you know, if you're in yourown little thing you can, the rest of the world can be going wherever29:00it wants and all you're worried about is did your grant get funded? Didthis happen or how are your patients doing? But when you're a chairman,that's--you got to worry about all of that plus you got to worry abouthow the state's doing, how the country's doing, and all of these-- soit's, it's, it's a big job. It's a challenge, but I enjoy it.

SMOOT: Let me step back and ask you about your impressions of the

original team of administrators and academicians here at the MedicalCenter. When you came in you met everybody--

NOONAN: --yes, um-hm--

SMOOT: --what were your impressions of these people?

NOONAN: Well, I was impressed with the quality of the people and of

their dedication. Uh, they, uh, I wouldn't want to say--(laughs)--theterm brainwashed, but they had really been, uh, brainwashed aboutwhat this place was all about. You got, uh, a lecture; you know,pictures -- the cornfield dean. It was a, this was a, uh, uh, therewas a real commitment to a, uh, a school that was going to be verymuch communicating one department with another. Uh, where we were30:00going to give total patient care. Where there would be collaborationbetween surgeons, psychiatrists, pediatricians, blah, blah, all thisand that philos-, philosophically wonderful utopia. Uh, and it wasfine because the hospital wasn't open. There weren't any patients.We got everybody that said all the right things. We all were greatand, uh, we were going to have a, we were going to have adult wardsand children wards, and they would all be mixed together. And thesurgeon and the psychiatrist and the medicine people would all makerounds, and obviously the medicine person will probably be in chargebecause that would be--(both laugh)--reasonable. Uh, but it was sortof interesting. Uh, once, uh, we got beyond, uh, five west with allof us in one little, uh, wing, it became, it became apparent very soonthat this utopia was not part of the real world. And although theywere able to be very selective, and as you, uh, got their key sort31:00of in early faculty, as the faculty began to grow, you got a lot ofsort of people who really came after the hospital was built, afterthe place was going, they didn't, it was just another medical schooland they were going to do their thing. And it wasn't very long beca-,before, uh, we had a surgical wing--(laughs)--and a medical wing anda psychiatry wing, and people pretty much did things. But I thinkthere has always been, um, uh, we've been a different school. Youknow, we, we came with a Department of Behavioral Science. Not manymedical schools had a Department of Behavioral Science. Um, that meantthat from very early on our students were very aware of the effectof medici-, of, uh, illness on people, the economics of illness andall of that. And so many of the things that people keep complainingabout, that nobody knows anything about, really has been part of ourexistence since we started here. I think our, our, our students knowhow difficult it is, they, it's not as hard as it used to be, but to32:00get from Prestonsburg to Lexington before the Mountain Parkway wentin, that was a long ride. Uh, our students knew more about thosethings. Uh, when you, uh, talk about getting medicine, and you've gotto be sure, do they have that in that particular town? Is there a drugstore in that town? These kinds of things. So I think we, we did havethat kind of a, uh, of a, uh, philosophy that we were interested in,in the whole patient and, and, uh, the effect of, uh, social economicsituation on, on medical care. And although that's become more popularnow and we're int-, it, it has always been part of our, uh, of, of thephilosophy of the school. Now, uh, how well, uh, this came across toall the students, I don't know. But I've been impressed that, by andlarge, both our students and our house staff that train here are quiteaware of that. They're, they're, they're, they understand a little33:00bit more about the real world and, of course, many of our students camefrom Appalachia. They know what it's like to be out there, so there's,there, there is this kind of a relationship. And I sort of laugh whenpeople talk about us being in the ivory tower, because I don't think,by and large, we were ever an ivory tower type school. Uh, now, theremay be, there may be some people in an ivory tower here and there maybe some basic scientists who are in their laboratories and all that,and that's fine, but I think the majority of people taking care ofpatients are pretty much aware of what life is like on the outside.And so it's, um, I always sort of laugh when they accuse us of notunderstanding about what's going on, when most of us have really beenaround and have been out there and know a little bit about what it'slike on the outside. And a number of the faculty have actually trainedon the outside. Dr. Doane Fischer, for example, in our department,was for many years in Hyden, Kentuc- -- Harlan, Kentucky. So, youknow, we have had people that have been out there that have, have come34:00in. Uh, so it, I think that was, uh, the, uh, this behavioral sciencepart was one thing. Um, it was interesting when we first came, youknow, there--since we didn't have a medical school here, there reallyweren't very man Kentuckians sort of in the early medical schooldays. The exception was Dr. Harold Rosenbaum, who was chairman ofradiology and a, a Kentuckian. And, uh, the other person that cameas a Kentuckian was Dr. John Reeves, who is from Hazard, Kentucky.He came as the, as a cardiologist, and Jack and I worked very closelytogether. We went on regional clinics together. He did cardiac cathson adults and I did them on children. We were very, very close, uh,very supportive of one another. Uh, uh, as new procedures came aboutin the cardiac cath lab, uh, I'd go down there and hold his hand whilehe did a, a, uh, transceptal puncture on an adult and he'd come downand hold my hand when I was doing something likewise in pediatrics.35:00Uh, uh, I really missed him when he went to Colorado after he'd beenhere for some years. Dr. Boro Sawarwitz (??) was the first chief ofcardiology. He had come from Vermont, uh, not, by way of several otherplaces--(both laugh)--but had been a, uh, fellow up in Vermont sometimeduring my training up there, so I had heard his, uh, his name, uh, andthen we were, you know, as a pediatric cardiologist, I have just beenblessed with outstanding surgeons. Uh, the very first heart surgeonwe had was Frank Spencer. Dr. Spencer came here, uh, having comeback from the Korean War as a hero; having really been one of the manyyoung surgeons in the Korean War that was doing surgery on the heartand blood vessels and all of this that, uh, had never been done in, uh,any other previous war. He had, of course, trained at Johns Hopkinsunder Dr. Blaylock and was a, uh, surgeon that--very skilled indoing congenital heart disease--and he was our first, uh, sur-, heart36:00surgeon that, particularly for children and, and adults as well. Dr.Ben Eiseman was chairman, but Frank was the, the, uh, cardiothorasticsurgeon primarily, and we just had a wonderful relationship. Uh, hewas a wonderful man--a very good surgeon. Uh, you know, it was justfun to work with him. Much mutual respect between the two of us. Ireally had a wonderful, uh, professional relationship with him, andthen he went to become chairman at, uh, New York University, one ofthe largest surgical programs in the country, and has, is still theredoing a very fine job. Uh, uh, when he left, uh, we, uh, were veryfortunate to get Dr. Gordon Danielson. Dr. Gordon Danielson camehere from Philadelphia--very talented, bright man--wonderful surgeon,uh, uh, particularly, uh, skillful, uh, technical surgeon--was, uh,recruited away by the Mayo Clinic. Uh, is, speaks at every conference37:00there is now, pretty much, on, uh, congenital heart disease. Hascertainly continued to be, uh, an outstanding, uh, nationally,internationally known person, and that was my second, uh, cardiacsurgeon. Uh, we had Dr. Ken Trinkle, who was here for awhile and ischief of cardiothorastic surgery in, uh, in, uh Texas--San Antonio. Wehad Lester Bryant, who was, uh, cardiac surgeon and, um, is now headof surgery--well, now, I think he's now a, I believe he's now dean atone of the medical schools in the, uh, I'm not sure just which one heis right now. He was at Johnson City in, at, head of surgery, but Ibelieve he's moved to be, uh, an administrator someplace.

38:00a very skillful surgeon, and, uh, uh fun to work with, uh, wonderfulsense of humor, a very good surgeon and he recruited Dr. Ed Todd, sothat when Joe left to go out to San Diego to do heart surgery, we wereleft with, uh, Dr. Edward Todd, who again, uh, is very gifted in beingable to put back together the most complex of, uh, congenital heartdefects and, uh, uh, has been able to operate on tiny babies with allkinds of complex, uh, lesions, and, um, so I've been very fortunatethat I've had really outstanding heart surgeons to work with throughoutthe, uh, the time I've been here. Um, and if you're doing pediatriccardiology and want to have your children's hearts fixed, that's veryessential, that you have somebody that you can trust that will do theirbest and that their best is very good, and we've been very fortunate39:00here to, uh, to have that kind of, uh, a surgical back-up. And, uh,so that's been, uh, that's been why I've certainly continued to liketo do pediatric cardiology here. Uh, I think that, you know, we hadEd Pellegrino as the first chairman of medicine, uh, you know, youjust had to meet Ed to know he was a very outstanding person. Uh, uh,Kurt Deuschle was our first chairman of community medicine. Again,uh, somebody who's gone on to make a name for himself, as Ed has. Uh,Bob Straus is still here, but in behavioral science, you know, again anationally, internationally known figure, so that I think, you'd haveto say that, uh, Dr. Willard did an outstanding job in recruitingreally a, uh, a very top-notch faculty, a young faculty at that time.But he picked them very wisely because they've done very well throughthe years and, uh, I guess probably I, I don-, it'd be interesting40:00to look at other new schools and see if any new school ever startedout with quite such a, um, talented, uh, group of, uh, departmentchairmen. Uh, it's not always easy to get, uh, great people to come toan unknown place and all of this and that, but I think, uh, you know,we've really been, we've been very fortunate in the, in the facultythat we have been able, uh, to attract. Uh, in pediatrics, I thinkwe've always had a strong pediatrics department. Dr. Nancy Hollandcame to do the renal disease in, uh, in pediatrics and, uh, I thinkwe were one of the, uh, earliest people to do renal transplants inchildren. We actually did renal transplants in children here beforethey did them at Cincinnati Children's. In fact, they sent one oftheir patients down to us for a, for a kidney transplant many yearsago. Uh, of course, there, everybody's doing them now, but in thosedays they, we, we were doing, we were one of the pioneers in doing41:00kidney transplants and certainly one of the earliest ones to do them inchildren and, uh, that's continued.

SMOOT: May I pause a moment?

NOONAN: Sure, um-hm.

[Pause in recording.]

NOONAN: You asked me also about the administrators. Uh, of course Dr.

Willard was a, uh, you know, uh, a unique individual with a lot ofvision and all that. Um, as a lowly assistant professor of--(Smootlaughs)--pediatrics, I really didn't get to know Dr. Willard all thatwell. I mean I knew him and all that, but, uh, I was not involvedwith him in meetings and all that, so I don't have a real personal,uh, view of Dr. Willard like many of the chairmen who were here atthat time do. Um, our first, uh, uh, Dick Wittrup, I believe wasthe first, uh, uh, hospital director and, you know, uh, they've kind42:00of changed what the, uh, uh, goals of this hospital or the--what istheir, what is their--mission of this hospital were, but I sat througha lot of that rhetoric when I came, and the mission of this hospitalwas to provide care for the people of, uh, Kentucky who were referredby a physician, who either--we had illnesses that could be treatedhere or would be good teaching cases. This was the, sort of thecharge to this hospital. It is true that in no time-- but it alsowas also part of it, which I think that's the part we've kind of leftoff now--that patients would not be denied admission to this hospitalfor any, uh, economic, racial, whatever kind of reason and so it wasclear from the beginning that patients would not be denied access tothe hospital because they did not have money. It was never writtendown or intended that this would be a hospital for people to come just43:00because they didn't have money, but you could see how it would be veryeasy to decide this was a very good teaching case who also happened tohave no money. Now, the other part was that they all were referred.Patients didn't just walk in and say I'd like to come to UK, they wereall referred by a physician. It wasn't until some years later when wesort of got into the competing business, started talking about primarycare and all this business that we then began to sort of try to recruitpatients directly to us. Um, so those are things that, you know, if Iwere king I would have, not have changed perhaps, because I think we,we have a unique role, uh, which we, we sort of do not have as much aswe did because as all teachers, when we train our students, they thendo our thing. So that, uh, in surgery and in medicine particularly,both of those fields, we have trained cardiologists and heart surgeonsand neurosurgeons and orthopedists and renal people so that what was44:00unique to this hospital is no longer unique. Now, fortunately inpediatrics we've been a little more-- well, we've--I think just becauseof the, uh, economics of it. You can't do pediatric renal disease outin private practice unless you've got a very, very large population sothat we, we have not trained a lot of, of tertiary care sub-specialistsin pediatrics who've gone out in the state. Uh, the ones we've, we'vetrained, uh, uh, some who've stayed right here on our faculty or havegone elsewhere, but we have not ever developed a large fellowshiptraining program. We've been more, uh, we thought our mission was totrain pediatricians to go out. We did not feel our job was to traina lot of sub-specialists who, which we didn't need in Kentucky, we hadthem here and had them in Louisville. Uh, we are training a number ofneonatologists because there is need for, for that throughout the stateas well. So I think we, uh, I think probably felt our mission was more45:00for, uh, training, uh, pediatricians, and so we, we've avoided thatproblem. And so in pediatrics I always, they, I finally have convincedeverybody, even here now, that pediatrics is different. They, they,they will agree pediatrics is different so that uh, uh, we, uh, we dofeel that since we are the only place that has, uh, tertiary care forchildren, that we need to continue the same sort of philosophy thatwe did before. Granted we, we certainly have to, and I'm certainlyvery supportive of the hospital's need to be, uh, solvent and to be inthe black so that we have a place to take care of anybody, but on theother hand I th-, and we, we certainly, uh, are cooperate in every waywe can, but on the other hand, it, it's going to be very difficult toset a percentage or a limit on patients that have no other alternative.Children with malignancies, leukemia--that's a disease that's getting46:00close to curable today, but it requires very, very dedicated, precisecare. We're part of a national, uh, you know, study section. Thesechildren are on protocols. You can't have somebody doing that, uh, onepatient a year. You've got to get them all together, so that if you'redoing, if you're the, if you're the place that takes care of childrenwith cancer you can't say, "Well, I'm sorry, we've already taken careof our quota of cancer children. You're just too bad, you can't come."We, we can't do that. I don't think we can do that, and so far wehaven't had to. Uh, I keep telling them, you know, there's a limit.There's only going to be so many children with cancer. There's onlygoing to be so many neonates born. There's only, you know, maybe morethan you'd like, but there's not no matter, there's not going to everbe a hundred babies in the NICU [neonatal intensive care unit], there'sonly so many babies born, and if we're going to take care of them wehave to be able to take care of the number that are needed. Uh, that,as you know, was a, a big story. That was probably one of more, ourmore exciting aspects was, uh, getting our neonatal intensive care unit47:00built. Uh, in 1974, when I became chairman, one of the things that Idid say at that time was that, uh, one of our highest priorities forthe Department of Pediatrics was to develop an outstanding neonatalprogram. We, uh, we had a premature nursery as such, which wasoutdated, not adequately staffed, not adequately equipped and notstaffed with the sort of modern day neonatologists. And actually I wasappointed--I think I was appointed chairman, I was--it was decided I wasgoing to be chairman like in January something, but I wasn't going tostart till July, but Dr. Wheeler said, "You can start running things,but--(both laugh)--he'd continue to get the money." ( laughs) I thinkis the way he put it, uh, and, um, uh, we, I, my first, uh, recruitmentwas Dr. Doug Cunningham, who's--came as our neonatologist, having48:00trained with Lou Gluck out in California, came with modern ideas, highexpectations and a commitment to quality care, and we, uh, had a roughfour or five years until we finally got the outstanding nursery wehave right now. And I think I am very proud of our neonatal intensivecare unit, the kind of care the babies get, the kind of dedicationthat Dr. Cunningham and Dr. Desai and, and Hermansen and now Dr.Pauly give to this unit. We can be very proud of that unit. It'sknown throughout the state and throughout the nation as an outstandingunit and I am personally very proud that, um, that this was one of thehigh priorities I had when I came as chairman, when I was appointedchairman, and, uh, um, I'm very proud that we have this kind of a unit.It did not come easy. It came amid, uh, a lot of, uh, shouting, uh,TV ads, uh, uh, legislative, uh, meetings and the like, uh, but it's,49:00it, it's there. It's something that was needed and it was somethingthat, um, I think, I personally did have perhaps some influence inhaving that come about as opposed to what perhaps was perceived as ahigh priority for the Medical Center at that time, uh, I think in thelong run it has, it has been a good thing for the, the Medical Center.It's one of the things we do that nobody else does and certainlynobody else does it as well and, uh, so that's, that's probably one ofmy things that would look back on with some, some, uh, pride.

SMOOT: Um-hm. Are there any other things that you would like to point

to that you look back with, uh, pride upon?

NOONAN: Well, I, I'm proud of our, our, our department as a, as a

group and about the, the, uh, residents we've trained that are out50:00there doing a very, uh, good job in pediatrics, both here and, uh,in other parts of the country. Uh, I just got back from a meetingat New Orleans, the Southern Society for Pediatric Research, ran intoone of our ex-residents who runs the, uh, intensive care nursery inArkansas, uh, heard about our neonatologist that's now at the OchsnerClinic doing a fine job down there. Those are very rewarding things,people that you've trained that go away and, and do a good job. Uh,seeing our house staff--our ex-house staff--sending patients back tothis hospital having just done a superb job in taking care of them.Um, I think, I've, very proud of the fact that, uh, Dr. Bryan Hallcame back to Kentucky from California to do our genetics program.He's a class person, uh, and is doing a fine job in that area, anarea that's high, highly important to, uh, Kentucky. This is a, uh,51:00uh, genetics' dream. (laughs) Uh, uh, Bryan has, has come here withan outstanding reputation, international and national reputation, andhas, uh, come back home. His family is from Paintsville, Kentucky.So he's a Kentucky boy returned and we're very, uh, pleased at thefine job he's doing. The other thing that I'm proud of is that one ofthe other things that I thought was important is that if we're goingto train people to be, uh, pediatricians we need to train them wellin general pediatrics, and, uh, there wasn't--you know, most pediatricdepartments in medical schools didn't have very much in the way ofgeneral pediatrics. They had somebody they called an outpatient doctorand we had, and our general pediatrician pretty much were the clinicdoctors, and then the specialists were the inpatient doctors, and Ithought, you know, you're not going to attract any bright, uh, young,52:00uh, pediatrician that's just finished their residency who's used totaking care of real sick kids, they're not going to be very happy tospend the rest of their life just sitting in the clinic, and that'snot a good role model because the people you're training are goingto go out and they're going to have to take care of sick children aswell. And so, uh, Dr. Fischer at that time was, uh, the, uh, personin general pediatrics and had a couple of people in his division. Um,Jackie Campbell was the first general pediatrician I recruited whenI came. She was one of our residents, very bright gal, trained. Andwe then decided we would dis-, we would have a division of generalpediatrics which would be involved with the inpatient as well as theoutpatient. So our general pediatricians have since that time takentheir turn on the inpatient service. They generally take care of theinpatients on the ward as well as the outpatient. And that divisionhas grown, uh, to, uh, well, it's, uh--Dr. Fischer kind of argues53:00about how many people they have, but there are five or six of them overthere and a few other people that help out, uh, and, uh, uh, this is Ithink, uh, another area that, which I am proud, that these now, whereI think we're giving a good role model to our house staff that youcan take care of patients in the hospital, you can take care of themin the, as an outpatient, um, you can stabilize a newborn baby, you,this is, this is what the kind of pediatrician we need out in EasternKentucky should be able to do. So I'm, I'm pleased with that. Uh, I,and there's one other area I was going to sor-, oh, I know. The otherarea that, when we took a sort of a poll of what do our house staff,what, what are we not teaching them they should know when they go outinto practice. We did that some years ago, and at time they said,"You know, we, we know how to do a lot of the acute care stuff andall that, but we're not very comfortable in dealing with the sort ofemotional problems that people have, bed-wetting and school phobias andall this kind of business," and there's a lot of that out in the world.54:00That's what people are worried about, that's what mothers talk to youabout. So Dr. Abe Fosson, who had been in practice at, uh, LexingtonClinic and then was over at Saint Joe's with us, then came pretty muchfull-time over here, decided he would take his sabbatical doing somechild psychiatry in England with the understanding that when he cameback he would be our psychosocial pediatrician and so, uh, that was inmy, in my term as chairman. Uh, Abe came back from, uh, uh, Englandand we developed the division of psychosocial pediatrics. So thatthis has been very much integrating into our pediatric program. Ourhouse staff are aware of how illness affects families and what kind ofthings and how--not only, we, we try to do it that we teach the housestaff how to manage it rather than sending them to another clinic.Psychosocial isn't a clinic you send them to, you get a consult andyou work together with them to learn how to manage these things, and,55:00uh, so I, I think we've tried to, uh, keep, um, uh, up to date aboutwhat the changing needs for pediatricians are and what the expectationof the public is and perhaps mostly what we think, uh, a child reallyneeds from a pediatrician, and all of these things are important. Youneed somebody that will, uh, understand their growth and development,see that they develop not only well physically, but mentally andemotionally and yet you want this fellow to be smart enough that ifthey really get sick they're going to recognize it and either takecare of it or know where to send it. And so we try to do all of thesethings and it's a, it's a, it's a big job and it's hard to do it inthree years, but, uh, I think we do it and we do it all right.

SMOOT: I think I can anticipate your answer to this question, but what

has been you impression of the quality of the students that you havebeen, uh, training at the university?

NOONAN: Well, I think that, you know, I think we're like most places.

56:00Our good students are, our very good students, are as good as studentsany place in the world. And, by and large, we have good medicalstudents. I think there may be a few in each class that you sort ofwonder how they got there. There're a few, and I think we're veryconcerned that there shouldn't be any. But, by and large, we have goodmedical students. I just was on service last month--on general, uh,pediatric service. I took the month of, uh, January and, uh, I hadthree students, all fine people, good students, uh, mature, dedicated,they're all going to be fine physicians. I don't know what grade theygot in biochemistry, and all those things. All I know is, as seeingthem as clerks in their junior year, we're going to be proud of allthree of those. Uh, Dr. Johnson, who was on the month before, hadfour students and I know he was happy with all four of his. Uh, I go57:00to all our grading sessions and, you know, throughout the course ofa year there may be two or three students in the whole year that wesort of really are concerned about. Uh, I think there will be lessof those. We're, we're trying very hard to, uh, to weed out studentsthat we're concerned may not be the kind of physicians we want them tobe later on by having more of an ongoing review. Uh, Dr. Fosson, inour department, is involved in that, one of those committees lookingat that. But I think we have good students. Well, look at our firstclass. You've got Bill Markesbery in our first class, uh, who'scertainly an outstanding person. I can remember almost everybody inthe first, uh, class of medical school--the first couple of years. Ican't rem-, I don't know a half of the people in the, a third of thepeople in the present class. Once they got that large it's hard toremember them all. Uh, but we've had good medical students.

we don't have more of a relationship. I do not think we have a badrelationship. I think on an individual we have a good relationship, butwe don't, we do not have as much interaction as I would like to have ushave and I think that's because everyone is very busy. This hospitalis not used by the pediatricians for their routine hospitalization ofchildren and, um, so we don't see them. It's difficult to run overhere to grand rounds when you've got to be somebody else. Parking'sdifficult, it's--we do have some that come. Uh, I feel bad I've notbeen as active in going to the Lexington Pediatric Society meetingsas I should. I do go occasionally and I certainly am supportive oftheir meetings. We have, uh, uh, you know, we've trained most of thepeople in town. Now, they're all friends of ours, they certainly refer59:00their sick patients, their, uh, tertiary, I mean their sub-specialitypatients to us. I guess I, I think at this point in time we mayneed to make it a real effort to become more involved with the localpediatricians. It's my perception and again I'd like to have thisreally documented, that the pediatricians right now are not happy, ingeneral, with the care of children in the Lexington hospitals. Uh,it is deteriorated from what it was ten years ago. Uh, ten years agoSaint Joe's [telephone ringing] had a, uh, a big, uh--excuse me, let meget that. Uh, we had Saint Joseph Hospital, which had a good pediatricunit. Our residents went over there, we had a, much more of arelationship with the practicing pediatricians because our house staffknew them over there. We would go over there to see patients. Whenwe, uh, no longer had a house staff at Saint Joe's, and as perhaps more60:00need for surgery beds came in and as particularly the surgery centeropened and much of the children's surgery was done as an outpatient,um, the economics of a pediatric ward became more unfavorable. Whenyou start taking care of very sick children in the hospital, you endup, unfortunately having a fair number of 'em who don't have verygood insurance. Uh, elective surgery, you know you don't do electivesurgery unless you've got some kind of insurance. So it's, and whenyou take all those patients and put them in the surgery center, youend up with a money losing, uh, ward, and hospitals have to stay inthe black. So, um, Saint Joseph eventually sort of, uh, decreasedthe number of pediatric beds; they closed their pediatric intensivecare unit. At the same time, uh, Good Samaritan's boasting it hasa pediatric unit and Humana comes in and says we're going to have apediatric unit, so, and Central Baptist has a few pediatric beds. So61:00all of the hospitals now are trying to get the pediatricians to bringtheir patients there and they're all saying they have a pediatric unit.But it turns out none of them, well, really has the kind of pediatricunit that Saint Joseph used to have and none of them have somethingthat we have here. They do not have, uh, nurses for twenty-fourhours a day that are trained and dedicated to taking care of children.They'll have a few nurses that ta-, and I think a lot of our nursesmoonlight over there on their off hours at different hospitals, theywill go in, but they don't have, uh, pediatric nurses as such that arearound the clock and, uh, there, there might be a ten bed pediatricwing, but there will be three pediatric patients and seven orthopedicpatients. Well, you know, the children don't really get the same kindof attention. So I have the feeling that our pediatricians are reallynot very happy with this. One of the things that I, I have proposedto the chancellor and I, I don't know whether it will go forward62:00or not, but I think that things have changed in Lexington, in thisFayette County area, and that because less children are admitted to thehospital, it perhaps makes sense to at least try to congregate all thechildren with fairly serious illnesses into one facility, and I'd liketo propose that instead of decreasing beds in pediatrics, we considerincreasing the number, and develop what they've done at Vanderbiltand at, uh, South Carolina, a so-called children's hospital within auniversity hospital and, which would mean we would need some more beds,which would mean the pediatricians could admit their sick meningitishere or their sick bronchialitis or whatever; take care of them in thishospital, get consultation if they think it's necessary. Our housestaff would be available to, uh, it would improve the, uh, the, thepatient population for our students and our house staff. I think, I'mquite sure it would improve patient care, which is what I'm really mostinterested in, and, um, uh, it would certainly give us a chance to have63:00our pediatricians become much more part of our, our whole scene. Uh,I don't know whether that will happen. To me it's something that hasto be very strongly supported by the pediatricians and the community.It's not something that we should go out and say, uh, look, we needsome more patients, let's everybody bring them here. I don't thinkthat's--I think the times have changed. I think if the pediatriciansperceive this as a need, that patient care would be improved if weput them all together, then we as a university hospital ought to be,uh, sensitive to this and look at this as another way of perhaps doinga thing here that they're not doing in every other hospital. Uh, Ithink it would be good for children; I think it would be good for ourteaching program, I think in the long run it would be good economicallyfor this hospital. And they may actually pay attention to it, because64:00I think that is an important thing today for any hospital that we haveto be economically, uh, solvent. As I've mentioned on many occasionsto them, when we talk about improving our patient mix, all those terms,I said, "I do not see any way that we are going to be able to in anyway influence, the number of no-pay children that come here or themedical, medical card patients that come here, um, and that our onlychance of improving the mix is by attracting private patients who arecurrently going to all the hospitals around town," and I think if youopened this hospital up and made it comfortable for the pediatriciansto come in and had, uh, rooms where mothers could stay with childrenand the like, uh, I don't see why they wouldn't come, but I don't know.That's something I think we ought to spend a little money in havingsome of those people come and do all their little surveys and go aroundand do it because I, I don't think it's something I should go out anddo. I think I should support it, I should maybe be behind the scenes65:00doing things, but I think it needs to come from the community andfrom the pediatricians, uh, there--that they perceive it as a need,then it will work. It won't work if we--if it's perceived as just theuniversity trying to gobble up something. There's so much paranoiaout there that it's very difficult to do anything without, and it's,uh, there's paranoia on all sides. Everybody is so afraid of what theother guy is doing, nobody will, you know, it's, that's, that's kind ofsad, that, but that's, you know, that's the way things are today.

SMOOT: Um-hm.

NOONAN: Uh, and I just want to be sure that in the middle of all this

that we're not doing things that are bad for children, and I thinkchildren very often are the ones that get sort of left out and get hurtwhen, uh, when the times get tough, it gets tougher for children and,and mothers than it does for the rest of the population.